本文選題：腦血管疾病　切入點：狹窄　出處：《大連醫(yī)科大學》2014年碩士論文

【摘要】：目的：探討缺血性腦血管�。↖schemic cerebral vascular disease，ICVD）患者腦動脈狹窄與ESSEN卒中危險評分(Essen stroke risk score,ESRS)及相關(guān)危險因素的相關(guān)性。 方法：連續(xù)納入482例行腦血管造影的癥狀性腦動脈狹窄患者，整理患者的臨床資料（包括性別、年齡、高血壓、糖尿病、既往心肌梗死、其它心臟病、吸煙、既往TIA或者卒中、外周動脈疾病、低密度脂蛋白、甘油三酯、膽固醇、高脂血癥病史、同型半胱氨酸、C-反應蛋白、尿酸等）并對其進行ESRS評分,記錄患者腦動脈狹窄的部位（前循環(huán)、后循環(huán)及顱內(nèi)動脈、顱外動脈）。將血管狹窄度分為輕度狹窄10%～49%，中度狹窄50%～69%，重度狹窄＞70%～100%。如果是串聯(lián)性狹窄則計算狹窄最嚴重處。按ESRS評分將患者分為卒中復發(fā)低危組（0～2分）及高危組（≥3分）。分析ESRS評分與腦血管狹窄程度及部位的相關(guān)性。以上各危險因素為自變量，，以血管狹窄為應變量，采用非條件Logistic回歸分析相關(guān)變量。 結(jié)果：482例缺血性腦血管病患者中，低危組198例(41.1%)，高危組284例（58.9%）。⑴高危組的年齡、高血壓、糖尿病、心肌梗死病史、周圍動脈疾病的比率高于低危組，差異有統(tǒng)計學意義（PO．05或PO.01）；而性別、吸煙的差異無統(tǒng)計學意義。⑵血管輕度狹窄64例(13.3%)，中度狹窄111例(23.0%)，重度狹窄或閉塞307例(63.7%)。Pearson直線相關(guān)分析顯示，ESRS評分與血管狹窄度呈正相關(guān)（r=0.095，P=0.037）。說明血管的狹窄度與ESRS評分是相關(guān)的，腦血管的狹窄度越大，ESSEN分值越高。⑶482例中，前、后循環(huán)均有狹窄者占52.1%（251/482），前循環(huán)狹窄者占29.0%（140/482），后循環(huán)狹窄者占18.9%（91/482）。高危組前、后循環(huán)均有狹窄者占61.6%（175/284），高于低危組的38.4%（76/198）；而低危組的前循環(huán)狹窄患者較多占40.4%（80/198），差異有統(tǒng)計學意義（PO.01）。⑷482例缺血性腦血管病患者中，顱外動脈狹窄者占45.9%（91/482），顱內(nèi)-外動脈均有狹窄著占90.5%（257/284），高于低危組的77.8%（154/198），差異有統(tǒng)計學意義（PO.01）。（5）以年齡、高血壓、糖尿病、既往心肌梗死、其它心臟病、吸煙、既往TIA或者卒中、外周動脈疾病、低密度脂蛋白、甘油三酯、膽固醇、高脂血癥病史、同型半胱氨酸、C-反應蛋白、尿酸等危險因素為自變量，以血管狹窄為應變量，采用非條件Logistic回歸分析，逐步剔除了關(guān)系無顯著性的變量，最后的回歸模式剩下了有差異的變量為高血壓、其它心臟病、高脂血癥史、尿酸。高血壓，其它心臟病(除外心肌梗死和心房纖顫)、高脂血癥史、尿酸為腦血管狹窄的獨立危險因素。 結(jié)論：缺血性腦血管病患者腦動脈狹窄程度與ESRS評分相關(guān)，ESRS評分不同時腦動脈病變的部位分布有區(qū)別。高血壓，其它心臟病(除外心肌梗死和心房纖顫)、高脂血癥史、尿酸為腦血管狹窄的獨立危險因素。
[Abstract]:Objective: to investigate the correlation between cerebral artery stenosis and ESSEN stroke risk score (Essen stroke risk score#en0#) and related risk factors in patients with ischemic cerebral vascular disease (ICVD). Methods: the clinical data of 482 patients with symptomatic cerebral artery stenosis, including sex, age, hypertension, diabetes, previous myocardial infarction, other heart disease, smoking, were analyzed. TIA or stroke, peripheral artery disease, low density lipoprotein, triglyceride, cholesterol, history of hyperlipidemia, homocysteine C-reactive protein, uric acid, etc. The sites of cerebral artery stenosis (anterior circulation, posterior circulation and intracranial artery) were recorded. Extracranial artery. The degree of stenosis is divided into mild stenosis and 49 degrees of stenosis, moderate stenosis of 50 to 69, severe stenosis of more than 70 to 100. If it is series stenosis, the most severe stenosis is calculated. According to ESRS score, patients are divided into two groups (0 ~ 2 points in low risk group of stroke recurrence) and high risk group (. The correlation between the ESRS score and the degree and location of cerebral vascular stenosis was analyzed. The above risk factors were independent variables. Vascular stenosis was used as dependent variable and non-conditional Logistic regression analysis was used. Results among 482 patients with ischemic cerebrovascular disease, 198 cases were in low risk group, and 284 cases in high risk group were 58.9% in age, hypertension, diabetes mellitus, myocardial infarction history, peripheral artery disease ratio was higher than that in low risk group. The difference was statistically significant, either PO.05 or PO.01. There was no significant difference in smoking between 64 cases with mild stenosis, 111 cases with moderate stenosis, and 307 cases with severe stenosis or occlusion. Pearson linear correlation analysis showed that there was a positive correlation between ESRS score and vascular stenosis. The greater the degree of cerebral vascular stenosis is, the higher the score of ESSEN is .3482 cases. In the patients with anterior and posterior circulation stenosis, the proportion of patients with stenosis of posterior circulation is 25.1 / 482U, the proportion of patients with anterior stenosis is 29.0 / 140 / 482N, and that of patients with posterior circulation stenosis is 18.9% / 4820.In the high risk group, The proportion of patients with stenosis of posterior circulation was 61.6 / 285, which was higher than that of low-risk group (38.4%), while that of low-risk group was 40.4 / 80 / 1980.The difference was statistically significant in patients with ischemic cerebrovascular diseases. The number of patients with extracranial artery stenosis was 45.9 / 482, and the intracranial / external artery stenosis was 90.5 / 257 / 284, which was higher than that in the low-risk group (77.8 / 154.The difference was statistically significant (P < 0.05).) Age, hypertension, diabetes, past myocardial infarction, other heart disease, smoking, past TIA or stroke, Peripheral artery disease, low density lipoprotein, triglyceride, cholesterol, hyperlipidemia history, homocysteine C-reactive protein, uric acid and other risk factors were independent variables, vascular stenosis as dependent variables, non-conditional Logistic regression analysis. The variables that had no significant relationship were gradually excluded, and the final regression model was left with the variables of hypertension, other heart disease, history of hyperlipidemia, uric acid, hypertension, Other heart diseases (excluding myocardial infarction and atrial fibrillation, history of hyperlipidemia and uric acid were independent risk factors for cerebrovascular stenosis. Conclusion: the degree of cerebral artery stenosis in patients with ischemic cerebrovascular disease is different from the distribution of cerebral artery lesions in the same time as ESRS scores. Hypertension, other heart diseases (except myocardial infarction and atrial fibrillation, history of hyperlipidemia), Uric acid is an independent risk factor for cerebrovascular stenosis.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R743.3

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